Life sciences · Journal article

Gastric Metastasis of Uterine Leiomyosarcoma Detected During Surveillance Endoscopy and Resected by Endoscopic Submucosal Dissection After Multiple Metachronous Metastases: A Case Report.

Den Open · July 7, 2026

Preliminary Why this matters to you Expert discussion

Early or partial results. Treat as a signal, not a conclusion.

AI Summary

This is a case report of a 69-year-old woman with uterine leiomyosarcoma who developed metachronous gastric metastasis 15 years after hysterectomy and was successfully treated by endoscopic submucosal dissection with en bloc resection and no adverse events. The report documents technical feasibility and suggests ESD may be a minimally invasive option for small gastric metastases in this population, but provides no comparative outcome data or follow-up durability.

What was studied

Single case report. One 69-year-old woman with prior uterine leiomyosarcoma (treated 15 years earlier) presenting with incidental gastric lesion on surveillance endoscopy, performance status 0, no evidence of non-gastric metastases at time of detection.. Intervention: Endoscopic submucosal dissection of gastric metastatic lesion. Japan (Oita University, Department of Gastroenterological and Pediatric Surgery).

Key findings

15-mm subepithelial gastric lesion with shallow central depression detected on surveillance endoscopy Endoscopic ultrasonography showed well-defined lesion confined to submucosal layer without muscularis propria invasion Biopsy confirmed metastatic leiomyosarcoma; immunohistochemistry positive for desmin and alpha-smooth muscle actin

Safety

ESD achieved en bloc resection of 30 × 28 mm specimen (tumor 16 × 12 mm) without adverse events in 31 minutes

Who this may help

This case suggests ESD may be feasible for diagnosis and minimally invasive resection of small gastric metastases from uLMS in selected patients with adequate performance status and no competing metastatic disease. However, the single case does not establish safety, efficacy, or long-term outcomes, and clinical decision-making should remain guided by overall prognosis and systemic disease control.

Plain-language summary

Single case report of rare gastric metastasis managed by ESD; demonstrates feasibility and technique but lacks comparative data, control group, or outcome follow-up to establish clinical utility.

Study design

As stated by the source record.

MethodsClinical history and imaging reviewed; esophagogastroduodenoscopy performed as part of routine surveillance; endoscopic ultrasonography and biopsy obtained for diagnosis; ESD performed using multibending endoscope with retroflexed submucosal dissection, followed by endoscopic clip closure; histopathological examination of resected specimen conducted.

DesignSingle case report

PopulationOne 69-year-old woman with prior uterine leiomyosarcoma (treated 15 years earlier) presenting with incidental gastric lesion on surveillance endoscopy, performance status 0, no evidence of non-gastric metastases at time of detection.

InterventionEndoscopic submucosal dissection of gastric metastatic lesion

SettingJapan (Oita University, Department of Gastroenterological and Pediatric Surgery)

Reported figures

Quoted from the source exactly as published.

Lesion size (endoscopy)15 mm

Resected specimen size30 × 28 mm

Tumor size (histology)16 × 12 mm

Procedure time31 min

Adverse eventsnone reported

Clinical bottom line

Caveats

Single case; no comparison group or series to assess reproducibility or generalizability.
No post-resection follow-up duration or oncologic outcome (progression, recurrence, survival) reported.
No data on whether ESD provided clinical benefit relative to alternative local management or observation.
Gastric metastasis from uLMS is described as extremely uncommon; unclear how often clinicians will encounter this scenario.

Evidence assessment

Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.

Study design

limited

Single case report; no comparator or control group.

Directness

moderate

Describes actual clinical presentation and management with procedural detail.

Consistency

insufficient

Single patient; no comparative data or replication available.

Risk of bias

moderate

Retrospective case documentation; selection and reporting bias inherent to single case.

Sample adequacy

limited

n=1; insufficient to characterize efficacy, safety, or generalizability of ESD approach.

Source abstract

Uterine leiomyosarcoma (uLMS) is a rare, aggressive uterine malignancy that usually metastasizes hematogenously, whereas gastrointestinal involvement is uncommon. A 69-year-old woman with uLMS treated by hysterectomy and adjuvant chemotherapy developed metachronous lung, sigmoid colon, gallbladder, and abdominal wall metastases. After treatment of these metastases, periodical surveillance endoscopy revealed a 15-mm subepithelial lesion with a shallow central depression in the lower gastric body. Endoscopic ultrasonography showed a well-defined submucosal lesion without muscularis propria invasion, and biopsy confirmed metastatic leiomyosarcoma. Endoscopic submucosal dissection (ESD) was performed, achieving en bloc resection without adverse events. This rare metachronous combination of gastric, colonic, and gallbladder metastases highlights that incidental gastric metastasis may occur during prolonged disease courses and suggests that ESD may be a useful minimally invasive option for local control of small gastric metastases.

Follow from this

Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.

Yuiko NagasawaWataru MiyoshinoDaisuke MinezakiRyo OgawaMasafumi InomataTakahiro Hiratsuka